Print T-53A (Rev. 7/9/2008) Clear Motor Vehicle Certificate of Title Lien Notice Instructions: All spaces on this form must be completed and forwarded "registered mail, return receipt requested" or delivered in person to the person holding the certificate of title. The lien claimant must retain the "registered mail, return receipt" and a copy of this notice. If someone other than the owner is holding the title, a copy of this notice must be forwarded to the owner. If the lien claimant personally makes delivery, a receipt must be obtained from the person holding the current title. This form must be typed, printed legibly by hand or electronically completed and printed from this Department’s website (www.dor.ga.gov) for signing and submission. Important: Any alteration or correction voids this form. To: Full Legal Name of Person Holding Title □ □ No ELT (Electronic Lien Title) Participant Yes ELT # __________________ Representative’s Signature_______________________ Street Address City, State and Zip Code Check Appropriate Box Below Indicating Type of Lien Mechanic’s Lien Child Support Lien For child support liens only, enter the obligator’s social security number here: ___________________________________ (Social Security Number of Obligator) Judgment Lien – For judgment liens only, a certified copy of the Fi.Fa. and the following information is required: Fi.Fa. Number Court Case Number County Where Fi.Fa. Obtained In compliance with §19-11-18 (child support lien) or §40-3-53 (judgment lien or mechanic's lien) of OCGA, you are hereby notified that: Lien Claimant’s Full Legal Name □ □ ELT (Electronic Lien Title) Participant Yes No ELT # ___________________ Representative’s Signature______________________ Street Address City, State and Zip Code gives notice that they have a right to have the following lien as described on the attached title application reflected on a Georgia Certificate of Title for the following described vehicle: Year Model Vehicle Make Vehicle Identification Number Requirements of Person Holding Title: Note: If you are an ELT (Electronic Lien Title) Participant the certificate of title is in electronic form: a title is not required to be submitted. The signature of the authorized representative as shown above is acknowledgement of this request. 1. 2. 3. Hold this notice of lien, attachments and the title for ten-days (10). If a notice contesting the lien is given or if ten-days (10) have elapsed without the lien being satisfied, you are to mail the attached title application, $18 title fee (if required) and other attached documents, if any, along with the certificate of title held by you for this vehicle to: Department of Revenue/Motor Vehicle Division, PO Box 740381, ATLANTA, GA 30374-0381. If the lien is satisfied within a ten-day (10) period of time, the application, notice, and fee (if required) must be returned to the lien claimant. A title fee is not required to record a child support lien. and If you do not have possession of the certificate of title described herein or if you cannot comply with this notice, check the following return this notice, fee (if applicable) and the documents to the lien claimant at the address shown above. You must include an explanation as to why you do not have the title or cannot comply. A title fee is not required to record a child support lien. The owner or person holding the certificate of title may contest the claimed lien by checking the following box , signing below and notifying any other interested parties. If the owner contests the claimed lien, this notice must be forwarded to the person holding the certificate of title and a copy of this form must be forwarded to: Department of Revenue/Motor Vehicle Division, PO Box 740381, ATLANTA, GA 30374-0381. Printed Name and Signature of Person Contesting Lien Printed Name and Signature of Lien Claimant Important: Any person who willfully and knowingly takes any action affecting the title to a vehicle other than as provided in §40-3-53 or §19-11-18 of the OCGA after having received a notice of lien as provided in this section is guilty of a misdemeanor.